A road map through the multi-faceted world of female genital cosmetic surgical techniques

Abstract

The demand for female genital cosmetic surgery (FGCS) has significantly increased in recent years for two reasons: the advancement of surgical operations and the increased attention to women's esthetic and sexual well-being. Three authors independently analyzed different databases up to April 1, 2024. They selected the relevant data according to inclusion and exclusion criteria. Two team members retrieved and evaluated the full text of the articles for eligibility, extracted the data independently, and included populations, intervention type, and outcomes using a pre-piloted standard method. Any disagreement over the eligibility of some articles was resolved through discussion with an external collaborator. Considering the growing interest in FGCS procedures, the present review aims to analyze the most up-to-date surgical techniques, to provide adequate evidence-based surgical training, in order to avoid complications. Labiaplasty aims to reduce excess labial tissue. To perform this procedure, it is possible to implement several techniques, that have recently been updated to ensure the lowest rate of complications and the best esthetic result. Vaginoplasty involves strengthening the vaginal wall and repairing vaginal lesions or asymmetries. Perineoplasty, the technique of choice in all scenarios in which perineal trauma occurs, is achieved by strengthening the perineal body and restoring the rectovaginal fascia. Other procedures described are labia majora augmentation, mons pubis surgery, clitoral hood reduction, lipofilling, and hymen reconstruction. Our review emphasizes that robust, evidence-based training is required before performing such procedures, to avoid ineffective and potentially harmful surgical practices.

Keywords: cosmetic surgery; evidence‐based training; labiaplasty; perineoplasty; vaginoplasty.

FIGURE 1

(a) Normal female genitalia. (b–d) Classification of labia minora hypertrophy proposed by Franco and updated by Gonzalez in 2015, based on the position: (b) anterior hypertrophy; (c) central hypertrophy; and (d) generalized hypertrophy.

FIGURE 2

Edge resection technique: Consists of creating a linear vertical incision on the labia minora and removing excess labial tissue by means of an excision line that follows the curve of the labia.

FIGURE 3

Wedge resection technique: After drawing the limits of resections, the edges are cut with a scalpel and then approximated. This technique allows for a noticeable reduction of the labia while maintaining a natural edge.

FIGURE 4

To perform wedge resection, two clamps are placed around the area to be cut: The first clamp is placed on the posterior part with an angle of 30° to the base, without impeding the blood supply, and the second clamp is positioned away from the clitoris.